tbuckley/cabot-search huggingface dataset:
Abstract 15334: Tunable Elastin-Like Protein (Elp)-Based Hydrogels for Cell Transplantation in Vascular Repair
Authors: Mahdis Shayan, Renato S Navarro, Michelle Huang, Sarah C Heilshorn, Ngan F Huang
Journal: Circulation (2022)

Introduction: Endothelial cells (ECs) can improve blood perfusion in diseased blood vessels; however, direct injection of cells significantly decreases their survival and functionality for angiogenesis. To address these limitations, we study a family of engineered extracellular matrices with tunable biochemical and biomechanical cues for enhanced survival and improved angiogenic behavior of primary human ECs. Hypothesis: We hypothesize that the biomechanical properties of ELP-PEG hydrogels will modulate EC survival and function in vitro. Methods: Engineered hydrogels, termed ELP-PEG, consists of two components of a hydrazine-modified elastin-like protein (ELP-HYD) and an aldehyde- or benzaldehyde-modified, polyethylene glycol (PEG-ALD or PEG-BZA), which interact with each other through hydrazone dynamic covalent chemistry (DCC) bonds to form ELP-PEG hydrogels. Stiffness is controlled by altering the number of PEG-ALD or PEG-BZA crosslinks, and the stress relaxation rate is tuned by varying the PEG-ALD crosslinks vs. PEG-BZA. Stiffness and stress relaxation rates of the hydrogels were assessed by dynamic oscillatory rheology. Afterwards, human umbilical vein endothelial cells (HUVECs) were encapsulated within gels to assess cell viability and spreading using a Live/Dead Cytotoxicity assay and confocal fluorescence imaging. Results: Stress relaxation rate in ELP/PEG-ALD is much slower compared with similar combination in ELP/PEG-BZA. Rheology measurements of the RGD-ELP/PEG-BZA (1.75%/1%) and RGD-ELP/PEG-ALD (1.25%/1%) hydrogels demonstrated a storage modulus of 700Pa. It confirms the tunability of stress relaxation rate with a constant stiffness. Cell viability assay demonstrated that both hydrogels could support high cell viability (&gt;90%) for 7 days. After 7 days, cell spreading increased in RGD-ELP/PEG-BZA hydrogels and tubular networks appeared inside the gels. However, cells did not form elongated morphology in RGD-ELP/PEG-ALD hydrogels, suggesting that stress relaxation rate and mechanical stiffness are key characteristics in modulating endothelial cell behavior. Conclusions: ELP/PEG-ALD/BZA promotes angiogenic behavior of ECs and is a promising candidate for cell delivery in vascular diseases.
Abstract 15340: Association of Serum Lipoprotein (a) Levels and Lipid Burden by Near Infrared Spectroscopy in Intermediate Coronary Artery Disease
Authors: Moon Seung SOH, Kwang-No Lee, Kyoung Woo Seo, Jin-Sun Park, Hyoung-Mo Yang, Hong Seok Lim, Byoung-Joo Choi, So-Yeon Choi, Gyo-Seung Hwang, Joon-Han Shin, Seung-Jea Tahk, Myeong Ho Yoon
Journal: Circulation (2022)

Introduction: The relationship between elevated lipoprotein (a) (Lp(a)) and poor prognosis in coronary artery disease (CAD) has been addressed for decades. However, data of mechanism of increased risk with plaque lipid burden has not been established. Hypothesis: This study aimed to investigate the association between Lp(a) and lipid burden in patients with intermediate CAD by Near Infrared Spectroscopy (NIRS). Methods: We retrospectively analyzed 128 patients with intermediate CAD who performed intravascular ultrasound (IVUS) during coronary angiography and checked Lp(a) level. The lipid core burden index (LCBI) for the 4-mm segments at the target lesion was calculated by NIRS. We divided the patients into 3 groups by calculating baseline Lp(a) tertile level. A mixed model adjusted for baseline sex, age, weight, pre-minimal luminal area, lesion length, apolipoprotein (Apo) E, Apo A1, Apo B100, total cholesterol, triglyceride, high density lipoprotein (HDL), low density lipoprotein (LDL), fasting glucose, past history, current medication including statin use was used to calculate the risk-adjusted target LCBI. Results: We enrolled 128 patients (60 years; male, 114; mean Lp(a) 21.03±20.84 mg/dl, Figure 1) and NIRS was taken in 90 patients among them. Mean and median target LCBI by NIRS were 78.4±60.3 and 62.0. Target LCBI significantly higher in the intermediate Lp(a) group than low Lp(a) group in risk-adjusted analyses (Lp(a)&lt;9; 45.7 versus 9≤Lp(a)&lt;19; 111.48, p =0.026, Table 1). However, between intermediate and high Lp(a) groups, there was no statistical difference (9≤Lp(a)&lt;19; 111.48 versus 19≤Lp(a); 86.41, p =0.774). Conclusions: Elevated Lp(a) level is independently associated with increased lipid burden of target lesion in intermediate CAD, and it’s important for treatment decision. Further investigation is needed to clarify the effect of Lp(a) in various type and severity of plaque.
Abstract 15485: Tectonic Infarct Analysis: A User-Friendly Standalone Software for Whole-Brain Infarct Volume Estimation From 2,3,5-Triphenyltetrazolium Chloride-Stained Tissues
Authors: Briana Santo, Shiau-Sing K Ciecierska, Carmon Koenigsknecht, TaJania D Jenkins, Donald Pionessa, Liza C Gutierrez, Ammad A Baig, Andre Monteiro, Robert King, Matthew J Gounis, Adnan H Siddiqui, Vincent M Tutino
Journal: Circulation (2022)

Introduction: Infarct volume measured from 2,3,5-Triphenyltetrazolium Chloride (TTC)-stained brain slices is critical for in vivo stroke models. However, current image tools are not automated and severely limited in their capability. Here, we developed an interactive, trainable software application that computes whole-brain infarct volume metrics from batches of serial TTC-stained brain sections. Methods: Male Wistar Rats ( n =21) received middle cerebral artery occlusion and were euthanized after 24 h. Brains were serially sectioned (2 mm, coronal), stained with TTC, and optically scanned (anterior and posterior sides). Manual annotations of infarcted regions and calculation of infarct volume were used as ground truth. We performed computational image analysis to segment brain tissue and develop a custom semantic segmentation model for infarct detection ( n =3 training cases) (Figure, top). Stroke parameters, including brain volume, infarct volume, infarct/non-infarct volume ratio (V), and % infarct were computed by measuring each feature per section, averaging over anterior and posterior faces, and summing across all slices. Results were compared against manual ground truth ( n =18 testing cases) using accuracy, f1-score, and Spearman correlation. The pipeline was then packaged as a standalone, opensource software named Tectonic Infarct Analysis (Figure, bottom). Results: The software performed well for brain (accuracy=0.95, f1-score=0.90) and infarct (accuracy=0.96, f1-score=0.89) segmentation. Strong, significant correlation was observed between manual and computational calculation of infarct parameters: V brain ( ρ =0.91, p &lt;0.001), V infarct (0.97, p &lt;0.001), V non-infarct (0.96, p &lt;0.001), and % infarct (0.81, p =0.001). The software reduced analysis time by 25 min per case vs. manual effort. Conclusions: Tectonic Infarct Analysis software offers a robust and adaptable approach for rapid TTC-based stroke assessment.
Abstract 15382: Geriatric HFpEF: When It Isn’t Hypertensive Heart Disease
Authors: David S Gruen, Marvyn Allen G Chan, Bisrat Teweldemedhin, Olamide Oyenubi, Patrick Benjamin, Gerald Kristoffer E Boy, Stephen Jesmajian, Bernard Gitler
Journal: Circulation (2022)

Introduction: Transthyretin amyloid cardiomyopathy (ATTR) is thought to be a rare cause of HF, but recent studies showed this is the cause of 30% of HFpEF patients older than 75. With new treatments for amyloidosis, timely diagnosis has become critical. Case: A 78-female with HFpEF, HTN, and diabetes followed for progressive functional decline and hospitalizations for HFpEF exacerbations. EKG at baseline showed LBBB with normal QRS voltages. Serial echocardiogram (echo) showed an ejection fraction (EF) of 60-70%, mild LVH, and moderate TR with RVSP &gt;50 mmHg. Latest echo showed progressive LA enlargement, MR, a new small pericardial effusion, and EF 50%. Regadenoson nuclear scan showed normal perfusion with preserved LVEF. Despite adequate control of her HTN, dyspnea continued to worsen. Because of this, the diagnosis of Cardiac amyloidosis was considered. Further review revealed a history of Carpal Tunnel Syndrome (CTS) and speckled pattern within the ventricular wall on echo. A technetium pyrophosphate scintigraphy ( 99m Tc-PYP) confirmed ATTR with grade three uptake, AL amyloid was ruled out with normal SPEP/UPEP, and she was started on Tafamidis. Discussion: Cardiac amyloidosis should be considered in HFpEF patients with functional decline despite medical optimization. It can mimic LVH caused by HTN on echo and easily dismissed in patients with traditional risk factors, but presence of CTS or lumbar spinal stenosis can be supportive. Traditionally ATTR is associated with low-voltage EKG, however this patient presented with normal QRS voltages for years, making the diagnosis more elusive. Conclusion: Advances in noninvasive imaging and treatments allow for early diagnosis of cardiac amyloidosis, reducing morbidity and mortality. Diagnosis is often delayed or missed, as features could be subtle and mimic other more common cardiac disease. Screening&amp;nbsp; 99m Tc-PYP for elderly patients with HFpEF could translate to improved outcomes
Abstract 15603: Simultaneous Suction Debulking of a 3 Cm Lead Vegetation in the Right Ventricle During Extraction
Authors: Naveed Mazhar, Shakeel Jamal, Ali Sheikh, Mohammed Qintar, Abdul-Fatawu Osman
Journal: Circulation (2022)

A 49-year-old male with a history of NICM EF 25% with dual-chamber AICD, lupus with nonbacterial endocarditis of aortic valve, IVC filter for recurrent DVT/PE presented with septic shock due to MRSA osteomyelitis and bacteremia. TTE showed 1.8 cm vegetation. The patient had idiopathic thrombocytopenic purpura, for which IVIG was administered. To avoid obligatory systemic exposure to heparin in the setting of ITP with a larger evacuation system and crossing the IVC filter with a large bore cannula, it was decided to proceed with Penumbra evacuation of lead vegetation with simultaneous laser extraction. A short 16F sheath was inserted through the right femoral vein for the procedure. A12F Medtronic Cryo Flex sheath was advanced through the IVC filter under fluoroscopy to provide steerability in the right atrium. TEE-guided Flex sheath positioned abutting the mass/vegetation. Suction only partially retrieved the mass. RA lead was removed using mechanical extraction tools via the left chest pocket. On repeat TEE evaluation, the mass/vegetation was 3 cm on the RV lead. Since we could not aspirate the mass, we used the extraction tools to peel the mass off the lead while providing simultaneous negative suction through the Penumbra cannula. The lead was successfully extracted. TEE showed no residual mass, no significant change in tricuspid regurgitation and no pericardial effusion. Mass biopsy showed calcified blood clots. The patient was discharged on IV antibiotics. Discussion: Most cases to date report using larger systems like AngioVac for extracting larger vegetations/masses with lead extraction. Aspiration tools have been shown to extract malleable masses with lesser procedural-related morbidity. Peeling and aspiration can be used concurrently to remove these masses without significant blood loss, downstream sheading and the need for systemic anticoagulation. Further technique development can benefit in removing under such challenging scenarios.
Abstract 156: Clinical Significance Of Left Ventricular Systolic Dysfunction After Cardiac Arrest
Authors: Rachel Beekman, Noah Kim, Kamil Faridi, Ehimen Aneni, Tiffany E Chang, Andrew Arakaki, Eva Kitlen, Elliott Miller, Akhil Khosla, Charles R Wira, David M Greer, emily j gilmore
Journal: Circulation (2022)

Introduction: Post-resuscitative transthoracic echocardiography (TTE) in cardiac arrest survivors has led to increased identification of left ventricular systolic dysfunction (LVSD). We sought to evaluate the association between LVSD and in-hospital outcomes. Methods: This is a retrospective review of all cardiac arrest patients with TTE documenting left ventricular systolic function during admission to a single tertiary care center between 2015 and 2020. We used a multivariable logistic regression adjusted for age, sex, race, cardiac arrest location, witnessed arrest, initial rhythm, etiology, and Charlson Comorbidity Index to evaluate the association between LVSD and in-hospital outcomes. LVSD was defined as ejection fraction (EF) &lt; 40% on TTE. Good neurologic outcome was defined as Cerebral Performance Categories 1-2. High vasopressor need was defined as peak norepinephrine-equivalent dose &gt; 1mcg/kg/min within 72 hours of arrest. Use of antiarrhythmic was defined as any dose of amiodarone, esmolol, or lidocaine within 72 hours of arrest. Results: Of 477 cardiac arrest patients, 321 (67.3%) met inclusion and were included in the analysis. Mean age was 60.4 ± 16.9 years with most being male (n= 192, 59.8%) and Caucasian (n=203, 63.2%). The majority had out-of-hospital cardiac arrest (n=212, 66%) and presented with a non-shockable rhythm (n=220, 68.5%). LVSD was more common in patients with shockable rhythm (48.5% (n =49) vs 22.6% (n= 49), p&lt;0.001). There was no difference in survival to hospital discharge, good neurologic outcome, or progression to brain death for patients with LVSD compared to those without (OR [95% CI] 1.04 [0.57-1.86], 0.87 [0.46-1.62], and 1.84 [0.70-4.79], respectively). LVSD was associated with increased use of antiarrhythmics (OR 2.85 [1.55-5.26]) and high vasopressor requirement (OR 1.81 [1.08-3.05]). Conclusion: LVSD was common in cardiac arrest patients, particularly those with shockable rhythm arrest, and was associated with increased vasopressor or antiarrhythmic use. There was no association between LVSD and survival to hospital discharge, functional neurologic outcome, or progression to brain death.
Abstract 15762: Model for Home-Based Physical Activity Program Utilizing Telemedicine for Fontan Patients
Authors: Julie Fernie, Lisette Wylie, Michal Schafer, Shelley D Miyamoto, Roni M Jacobsen
Journal: Circulation (2022)

Introduction: Fontan patients have decreased exercise capacity. The COVID-19 pandemic exacerbated the variable adherence to hospital-based physical activity programs, which improve exercise capacity and attenuate the expected decline in aging Fontan patients. A positive pediatric exercise capacity trajectory has been reported to predict better adult Fontan outcomes. We designed and implemented a reimbursable 12-month, home-based, individualized physical activity program for Fontan patients utilizing a telemedicine model. Methods: Eligible participants must be able to complete a cardiopulmonary exercise test (CPET) and demonstrate ability to adhere to a 12-month exercise prescription. Assent and consent are obtained. CPET and informal surveys of physical activity self-efficacy are completed at enrollment and graduation. An individualized exercise prescription is provided, with focus on skeletal and respiratory muscle strength training and aerobic activities. Participants receive a Garmin© device to monitor adherence. A cardiologist, nurse coordinator, and exercise physiologists comprise the team and regularly communicate with participants, starting with weekly check-ins that gradually space out to monthly as participants gain confidence. Results: Since program initiation, 9 participants have completed the program and 3 remain active. For the 9 graduates, all scheduled in-person and telehealth visits were completed. At completion of the 12-month program compared to baseline, there was no difference in maximal or submaximal oxygen consumption (VO2), peak heart rate, or oxygen saturation, but there was a significant increase in systolic blood pressure (144 ± 16 vs 162 ± 15, p-value 0.004) and minute ventilation (68.8 ± 19.3 vs 76.8 ± 22.1, p-value 0.012) at peak exercise. Per subjective report, all graduates had increased confidence related to exercise. There were no adverse events in any participant. Conclusions: A novel, home-based, 12-month individualized physical activity program using telemedicine was successfully implemented, with no adverse events. A larger study is needed to better assess change in VO2 and other qualitative and quantitative parameters, although the lack of decline in exercise capacity is encouraging.
Abstract 15814: Postoperative Surveillance Imaging Following Elective Aortic Hemiarch Replacement
Authors: Cenea Kemp, Zihan Feng, R. Wilson King, Leighton McCabe, Muhammad Aftab, T Brett B Reece
Journal: Circulation (2022)

Introduction: The optimal protocol for imaging following aortic hemiarch replacement remains a topic of debate with varied intervals at each institution. For the last 3 years, our institution has surveilled patients at 3 months, yearly for 3 years, and at 5 years. Hypothesis: We hypothesize surveillance CT scans performed at 3 months will identify any pathologies related to the ascending aortic repair that will require re-intervention; additional imaging may be superfluous. Methods: Using our single institution-maintained database, 348 patients who underwent an elective aortic hemiarch repair between February of 2010 and December of 2021 were identified. One patient with a restricted chart was excluded. The timing for and stability of surveillance imaging was reviewed, paying special attention to pathology associated with the repair. Results: Of the 347 patients, 274 completed surveillance imaging. 231 patients had their initial imaging around 3 months following the operation, 126 patients completed imaging around one year, and 72 patients were imaged 2-10 years post-operatively with some patients undergoing multiple scans during this period. Ten patients required re-intervention; of these 10, two patients demonstrated pathology, on CT scan, associated with the actual ascending aortic repair. These two patients developed a pseudoaneurysm (PSA), one at the distal aspect of the repair and one at the left ventricular outflow tract. Another two patients had degeneration of known distal aortic aneurysms. The two PSAs were intervened upon within the first 3 months and the degenerating aneurysms were intervened upon at 1 and 2.5 years post-operatively. Conclusions: These data support surveillance imaging completed at 3 months following hemiarch replacement is sufficient to identify pathology related to the repair. While other indications may dictate ongoing surveillance, for most patients, the need for further imaging is potentially zero.
Abstract 15352: Lung Endothelial Transport in Glypican 1 Knockout Mice
Authors: Stephen Black, Evgeny A Zemskov, Joao Carvalho-de-Souza, Andreia Chignalia
Journal: Circulation (2022)

Introduction: Pulmonary edema is a life-threatening condition that can result from the acute increase in hemodynamic forces in the lung vasculature. The mechanisms whereby pulmonary edema develops are unresolved but increased lung endothelial permeability may be important. The endothelial glycocalyx is a surface layer known to mediate the effects of mechanical forces in the lung vasculature by eNOS-dependent mechanisms. Among the components of the glycocalyx, glypican 1 (Gpc1) is considered a potential mechano-transducer due to its physical interaction with the cellular membrane. Herein we sought to investigate the mechanisms whereby Gpc1 regulates pulmonary permeability. Hypothesis: We hypothesize that Gpc1 regulates endothelial transport by eNOS-dependent mechanisms. Methods: Mouse lung endothelial cells (MLEC) isolated from male and female wild-type (WT) and Gpc1 knockout mice (Gpc1KO, 6-8 weeks old) were used. Endothelial transport was assessed by dextran permeability in vitro, lung barrier stability was assessed by TEER, eNOS pathway was assessed by immunoblotting. To assess the role of eNOS to Gpc1 effects on endothelial transport, MLEC were exposed to an eNOS decoy peptide. Results: Gpc1KO MLEC formed a tighter barrier in vitro when compared to WT MLEC (3.18±0.11 [Gpc1KO] vs 2.34±0.11 [WT], normalized TEER, n=3/group). This was preserved during high pressure conditions. High pressure increased transcellular but not paracellular transport in both WT and Gpc1KO MLEC (1.8 fold in WT and 1.2 fold in Gpc1KO, n=6/group). Gpc1KO showed decreased eNOS expression (0.3 fold, n=4/group ) and activity during (1.947±0.32 [WT] vs 1.316±0.13 [Gpc1KO], n=4/group). The eNOS decoy peptide increased transcellular transport only in Gpc1KO MLEC (3 fold, n=5/group). Conclusions: In conclusion, these data suggest that intracellular transport may be the main mechanism for pressure-induced changes in endothelial permeability in MLEC . The mechanisms whereby Gpc1 regulates transcellular transport seem to be associated with eNOS signaling. This may be important for the management of acute changes in pressure seen in clinical settings when NO donors are used as vasodilators to decrease blood pressure.
Abstract 197: Location, Location, Location! Association Of Success In Transthoracic Echocardiography Image Acquisition With Location During Cardiopulmonary Resuscitation.
Authors: Ghania Haddad Essaihi, Daniel Jafari, Casey Owens, Robert Ellspermann, Timmy Li, allison cohen, Lance B Becker, Daniel Rolston
Journal: Circulation (2022)

Introduction: Currently, no consensus exists regarding the ideal location for obtaining a transthoracic echocardiography (TTE) image during cardiopulmonary resuscitation (CPR). Of the three common locations, sub-xiphoid (SX), parasternal (PS) and apical (AP), the SX is most frequently used in cardiac arrest (CA) to avoid interfering with CPR. The recent adoption of mechanical chest compression devices may have led to increased use of alternate locations. We aim to assess the association between successful TTE image acquisition and the locations, also to compare the duration of CPR interruptions at each location. Hypothesis: We hypothesized that PS location will have a higher success rate compared to SX, but not a longer CPR interruption time. Methods: This is a retrospective study of all video-recorded non-traumatic, CA patients ≥18 years old in a quaternary care Emergency Department (ED) from 08/07/2019 to 05/18/2022 where an intra-arrest TTE was performed. Video recordings of cardiac arrest patients were reviewed by 2 physicians with years of experience and a well-established process. Successful image acquisition was defined as 1) visualization of the heart on the ultrasound machine or 2) clinicians verbalizing visualization in the video recording. Chi-square and Kruskal-Wallis tests were performed to compare the success rates and duration of CPR interruptions based on TTE locations. Our health system’s Institutional Review Board approved the conduct of this study. Results: A total of 59 patients yielded a combined 154 video recorded TTE attempts 90 (58.4%) SX, 56 (36.4%) PS, and 8 (5.2%) AP. Median age was 81 years, 50.8% female, 81.4% non-shockable initial rhythm, and 89.8% were receiving mechanical CPR. Because there were only 8 AP attempts, PS and SX were the only locations analyzed. PS was successful in 89.3% (68 of 90) compared to 75.6% (50 of 56) for the SX (p=0.04). The median duration of interruptions for PS was 17.5 seconds (IQR: 12.0, 22.0) compared to 15 seconds (IQR: 11.0, 24.0) for SX (p=0.5). Conclusion: During CPR, PS location for TTE image acquisition is associated with higher success when compared to SX. However, the median CPR interruption times are not significantly different.